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Submitted on 18 Jan 2010
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Oncologic outcome after extraperitoneal laparoscopic radical prostatectomy: midterm follow-up of 1115
procedures.
Alexandre Paul, Guillaume Ploussard, Nathalie Nicolaiew, Evanguelos Xylinas, Norman Gillion, Alexandre de la Taille, Dimitri Vordos, Andras
Hoznek, René Yiou, Claude Clément Abbou, et al.
To cite this version:
Alexandre Paul, Guillaume Ploussard, Nathalie Nicolaiew, Evanguelos Xylinas, Norman Gillion, et al.. Oncologic outcome after extraperitoneal laparoscopic radical prostatectomy: midterm follow-up of 1115 procedures.. European Urology, Elsevier, 2010, 57 (2), pp.267-72. �10.1016/j.eururo.2009.09.029�.
�inserm-00447994�
Fig 1. Biochemical progression-free survival stratified by preoperative PSA
0 ,2 ,4 ,6 ,8 1
Survie Cum.
0 10 20 30 40 50 60 70 80 90
Temps
Survie Cum. (3) Survie Cum. (2) Survie Cum. (1) Kaplan-Meier Graphe de Survie Cum . pour Suivi sans progre
Variable censure : Porgession oui/non Facteur : PSA groupé
Fig 2. Biochemical progression-free survival stratified by Gleason score
0 ,2 ,4 ,6 ,8 1
0 10 20 30 40 50 60 70 80 90
Fig 3. Biochemical progression-free survival stratified by surgical margins
0 ,2 ,4 ,6 ,8 1
Survie Cum.
0 10 20 30 40 50 60 70 80 90 Temps
Survie Cum. (positive) Survie Cum. (négative)
Kaplan-Meier Graphe de Survie Cum . pour Suivi sans progre Variable censure : Porgession oui/non
Facteur : MARGES
__ PSA < 10ng/ml __10 ≤ PSA < 20 ng/ml __20 ng/ml ≤ PSA
P rogr essi on fr ee surviva l (%)
(months)
P rogr essi on fr ee surviva l
__ Gleason score < 7 __ Gleason score = 7 __ Gleason score > 7
(months)
__ Negative surgical margins
__ Positive surgical margins
P rogr essi on fr ee surviva l
(months)
Fig 4. Biochemical progression-free survival stratified by pathological stage
0 ,2 ,4 ,6 ,8 1
0 10 20 30 40 50 60 70 80 90
Survie Cum. (pT4) Survie Cum. (pT3b) Survie Cum. (pT3a) Survie Cum. (pT2) Survie Cum. (N1)
Fig 5. Biochemical progression-free survival stratified by pathological stage and surgical margins
0 ,2 ,4 ,6 ,8 1
Survie Cum.
0 10 20 30 40 50 60 70 80 90
Temps
Survie Cum. (positive/pT3b) Survie Cum. (positive/pT3a) Survie Cum. (positive/pT2) Survie Cum. (négative/pT3b) Survie Cum. (négative/pT3a) Survie Cum. (négative/pT2)
Kaplan-Meier Graphe de Survie Cum . pour suivi Variable censure : prog
Variable de stratification : m arges Facteur : stade
__ pT2 __ pT3a __pT3b __pT4 __pN1
P rogr essi on fr ee surviva l
(months)
__ pT2/SM- __ pT3a/SM- __pT2/SM+
__pT3b/SM- __pT3a/SM+
__pT3b/SM+
(months)
P rogr essi on fr ee surviva l
Table 1 : Preoperative patient characteristics
No. pts 1115
Mean age (range) 62.5 (42-81)
Clinical stage (%)
T1a-b 18 (1.6)
T1c 894 (80.2)
T2 193 (17.3)
T3 10 (0.9)
Mean PSA (ng/ml) 9.8 (0.8-99)
Gleason score (%)
<7 739 (66)
=7 326 (29)
>7 50 (5)
Table 2 : Postoperative patients characteristics Stage
Total Positive margin (%)
Gleason score (%)
pT pN <7 =7 >7
pT2a pN0/pNx 126 (11.2%) 7 (5.5) 76 (6.7) 47 (4.2) 3 (0.3) pT2b pN0/pNx 30 (2.7%) 3 (10) 10 (1) 19 (1.6) 1 (0.1) pT2c pN0/pNx 508 (45.6%) 97 (19.1) 175 (15.6) 323 (29) 10 (1)
pT2c pN1 3 (0.2%) 0 0 3 (0.2) 0
pT3a pN0/pNx 250 (22.4%) 82 (32.8) 20 (2) 197 (17.6) 33 (2.8)
pT3a pN1 5 (0.5%) 2 (40) 0 2 (0.2) 3 (0.3)
pT3b pN0/pNx 100 (9%) 41 (41) 3 (0.3) 56 (5) 41 (3.7)
pT3b pN1 10 (1%) 3 (30) 0 7 (0.7) 3 (0.3)
pT4 pN0/pNx 77 (6.9%) 57 (74) 4 (0.3) 45 (4) 18 (2.6)
pT4 pN1 6 (0.5%) 4 (66.6) 0 2 (0.2) 4 (0.3)
Table 3: Multivariate Cox proportional hazard model for different variables for prediction of biochemical recurrence risk
Risk Ratio 95% CI P value
PSA < 10 ng/ml 1
PSA 10-20 ng/ml 1,243 0,795-1,943 0,339
PSA ≥ 20 ng/ml 2,920 1,743-4,894 <0,0001
Gleason score < 7 1
Gleason score = 7 1,280 0,583-2,809 0,538
Gleason score > 7 4,447 1,868-10,584 0,001
pT2 1
pT3a 2,759 1,640-4,643 <0,0001
pT3b 3,682 1,928-7,032 <0,0001
Negative lymph nodes 1
Positive lymph nodes 5,606 2,904-10,825 <0,0001 Negative surgical margin 1
Positive surgical margin 2,717 1,817-4,063 <0,0001 (95% CI: 95% confidence interval, PSA: prostate-specific antigen)
Table 4 : Oncological results of open, TLRP and ELRP prostatectomy
Progression-free survival (%)
% Surgical margins N°
References Pts
5-year 3-year
pT3 pT2
pT3 pT2
pT3 pT2
Open prostatectomy
68.7 90
78.7 92.5
20.9 1778
Catalona and Smith
[19]60 75
75 85
26.4 -
2494 Han et al
[17]75.3 94.9
85.3 95.6
12.8 1000
Hul et al
[21]TLRP
- -
67 89
31.1 15.5
1000 Guillonneau et al
[9]68.2 89.5
71.6 95.2
31.8 7.4
500 Rassweiler et al
[10]- -
78.6 95.4
51.5 13.6
1000 Lein et al
[23]- -
51 91.8
68 27.5
136 Hara I
[24]- -
78.5 98.2
39.3 6.2
528 Pavlovich et al
[18]69 83
- - -
-
[16]
